title: Can routine automated urinalysis reduce culture requests?
abstract: OBJECTIVE
  There are a substantial number of unnecessary urine culture requests. We aimed to investigate whether urine dipstick and microscopy results could accurately rule out urinary tract infection (UTI) without urine culture.
  
  
  METHODS
  The study included a total of 32,998 patients (11,928 men and 21,070 women, mean age: 39 ± 32 years) with a preliminary diagnosis of UTI and both urinalysis and urinary culture were requested. All urine cultures were retrospectively reviewed; association of culture positivity with a positive urinalysis result for leukocyte esterase (LE) and nitrite in chemical analysis and pyuria (WBC) and bacteriuria in microscopy was determined. Diagnostic performance of urinalysis parameters for detection of UTI was evaluated.
  
  
  RESULTS
  In total, 758 (2.3%) patients were positive by urine culture. Out of these culture positive samples, ratios of positive dipstick results for LE and nitrite were 71.0% (n=538) and 17.7% (n=134), respectively. The positive microscopy results for WBC and bacteria were 68.2% (n=517) and 78.8% (n=597), respectively. Negative predictive values for LE, nitrite, bacteriuria and WBC were very close to 100%.
  
  
  CONCLUSIONS
  Most of the samples have no or insignificant bacterial growth. Urine dipstick and microscopy can accurately rule out UTI. Automated urinalysis is a practicable and faster screening test which may prevent unnecessary culture requests for majority of patients.
authors.affiliation: Department of Medical Biochemistry, Ankara Training and Research Hospital, Ministry of Health, Cebeci, Ankara 06340, Turkey.
authors.forename: Damla
authors.initials: D
authors.lastname: Kayalp
authors.forename: Kubra
authors.initials: K
authors.lastname: Dogan
authors.forename: Gozde
authors.initials: G
authors.lastname: Ceylan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Senes
authors.forename: Dogan
authors.initials: D
authors.lastname: Yucel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001437:Bacteriuria / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine; D018929:Cell Culture Techniques / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011934:Reagent Strips; D016482:Urinalysis / Q000379:methods*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000382:microbiology; D014556:Urine / Q000382:microbiology*
chemical_list: D011934:Reagent Strips
keywords: Bacteriuria; CFU; Culture; DOR; Data mining; Evidence-based laboratory medicine; LE; LR; NPV; PPV; ROC; Rational test requesting; UTI; Urinalysis; Urinary tract infection; WBC; colony forming units; diagnostic odds ratio; high power field; hpf; leukocyte esterase; likelihood ratio; negative predictive value; positive predictive value; receiver operating characteristics; urinary tract infection; white blood cell